Online Patient Registration Form

Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection.

Patient Registration Form

Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office.

This form contains confidential information and is delivered to your doctor through a secure Internet connection.

Comments

Privacy Policy

Cancellation/No Show Policy

Dear Patients:

Our optometrists take the time to explain the results of your eye exam, describe your options and
listen to your eye care needs. Because maintaining good eye health is an ongoing partnership, we encourage
you to ask questions and share your health information, which could be vital to monitoring, diagnosing and
treating potential vision problems.

In our partnership, we ask for mutual respect of time. If there is a conflict on our part, we will notify
you in good timing. Just as we would ask you to notify us 24 HOURS in advance for an appointment
cancellation. Failure to do so will result in a CHARGE OF $50.00. You are responsible for no show/late
cancellation payments, not your insurance.

I understand that it is my responsibility to understand the coverage of my vision plan or plans, to be sure that I
am eligible to obtain covered services in this office, and that I am responsible for payment of any non-covered
services.

I understand and agree that, (regardless of insurance statues), I am ultimately responsible for the balance on
my account for any professional services or materials rendered.

Hours

Monday:8:00 AM - 5:00 PM

Tuesday:9:00 AM - 6:00 PM

Wednesday:9:00 AM - 5:00 PM

Thursday:8:00 AM - 5:00 PM

Friday:8:00 AM - 3:00 PM

Weekends:Closed

Saturday appointments are also available. Please contact our office for scheduling details. We close the office on Tuesday for lunch from the hours of 1:00 to 2:00. Voice mail is available during that time.

Monday:8:30 AM - 5:00 PM

Tuesday:8:30 AM - 5:00 PM

Wednesday:8:30 AM - 5:00 PM

Thursday:8:30 AM - 5:00 PM

Friday:Closed

Weekends:Closed

Closed for lunch everyday from 12:00-1:00 Voicemail is available during this time.

Map

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